<form id="add-form" class="form-horizontal" role="form" data-toggle="validator" method="POST" action="">

    <div class="form-group hide">
        <label class="control-label col-xs-12 col-sm-2">{:__('Presentation_patient_char_id')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-presentation_patient_char_id" data-rule="required" data-source="presentation/patient/char/index" class="form-control selectpage form-control" name="row[presentation_patient_char_id]" type="text" value="{:$_GET['cid']}">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Parent_identification')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-parent_identification" class="form-control form-control" name="row[parent_identification]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Date_of_birth_of_parent')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-date_of_birth_of_parent" class="form-control datetimepicker form-control"  data-date-format="YYYY-MM-DD" data-use-current="true" name="row[date_of_birth_of_parent]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Age_of_parent')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-age_of_parent" class="form-control form-control" name="row[age_of_parent]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Age_of_parent_number')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-age_of_parent_number" class="form-control form-control" name="row[age_of_parent_number]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Age_of_parent_unit')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-age_of_parent_unit" class="form-control form-control" name="row[age_of_parent_unit]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Last_menstrual_period_date')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-last_menstrual_period_date" class="form-control datetimepicker form-control"  data-date-format="YYYY-MM-DD" data-use-current="true" name="row[last_menstrual_period_date]" type="text">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Body_weight_kg_of_parent')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-body_weight_kg_of_parent" class="form-control form-control" name="row[body_weight_kg_of_parent]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Height_cm_of_parent')}:</label>
        <div class="col-xs-12 col-sm-8">
            <input id="c-height_cm_of_parent" class="form-control form-control" name="row[height_cm_of_parent]" type="number">
        </div>
    </div>
    <div class="form-group">
        <label class="control-label col-xs-12 col-sm-2">{:__('Sex_of_parentd')}:</label>
        <div class="col-xs-12 col-sm-8">
                        
            <select  id="c-sex_of_parentd" class="form-control selectpicker" name="row[sex_of_parentd]">
                {foreach name="sexOfParentdList" item="vo"}
                    <option value="{$key}" {in name="key" value=""}selected{/in}>{$vo}</option>
                {/foreach}
            </select>

        </div>
    </div>
    <div class="form-group layer-footer">
        <label class="control-label col-xs-12 col-sm-2"></label>
        <div class="col-xs-12 col-sm-8">
            <button type="submit" class="btn btn-success btn-embossed disabled">{:__('OK')}</button>
            <button type="reset" class="btn btn-default btn-embossed">{:__('Reset')}</button>
        </div>
    </div>
</form>
